Amiodarone is currently the most effective anti-arrhythmic drug for the treatment of atrial fibrillation. Its chronic use, however, has been associated with serious extra-cardiac adverse effects. Dronedarone is a new anti-arrhythmic drug that does not possess the different organ toxicities associated with amiodarone. With the addition of a methylsulfonyl group and the removal of iodine moieties, dronedarone has lower tissue accumulation and a shorter half-life than amiodarone. Dronedarone is a potent blocker of multiple ion currents, including the rapidly activating delayed-rectifier potassium current, the slowly activating delayed-rectifier potassium current, the inward rectifier potassium current, the acetylcholine activated potassium current, peak sodium current, and L-type calcium current, and exhibits antiadrenergic and coronary vasodilatatory effects. Although less effective than amiodarone as a rhythm-control agent, dronedarone has been shown to reduce ventricular rate and AF recurrence and it is the first anti-arrhythmic drug shown to reduce the combined outcome of cardiovascular mortality and hospitalization in AF patients. Dronedarone, however, is contraindicated in patients with moderate to severe heart failure. The most common side-effects associated with dronedarone are gastrointestinal including nausea, vomiting and diarrhea. This article will review the current evidence of safety and effectiveness of dronedarone in treating patients with atrial fibrillation and the position of this new drug in the currently available anti-arrhythmic armamentarium will be discussed.
Ngai-Yin Chan, Suet-Ting Lau, Chu-Pak Lau, Dronedarone: A New Generation of Anti- arrhythmic Drug for the Treatment of Atrial Fibrillation Journal of the Hong Kong College of Cardiology 2010;18(1) https://doi.org/10.55503/2790-6744.1059
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